Group B Strep prevention with probiotics

Archived User

Group B Strep prevention with probiotics

July 23, 2008 02:36 AM

Henci (and any others they may be able to shed light)-

I am a doula currently working on my bachelor's in nursing to
eventually become a CNM and attend homebirths after my indentured
servitude is up. I would like to know if there is any valid data
(studies or clinical trials) that show that probiotic
supplementation through the diet or using probiotic preparations
directly on or in the vagina will prevent GBS colonization. I read
blogs about stillbirth often because it is what I most fear about
becoming a midwife and there seems to be some evidence that 4-10
percent of unexplained stillbirth may actually be caused by
intrauterine infections caused by GBS.

In my reading of these blogs I came across a particularly well
educated woman with a science background of some kind that was
pregnant after stillbirth. An intrauterine GBS infection with
an intact bag of waters played a role in the death of her baby
and she and her doctor had layed out a plan to do monthly GBS tests
throughout the pregnancy, treating with antibiotics anytime GBS was
detected. Another person commented that the antibiotics may cause
the GBS colonization to worsen and suggested a daily intake of
probiotic foods and/or a probiotic supplement to prevent
colonization.

To this suggestion the pregnant woman replied that there was no
evidence that probiotics could help suppress GBS colonization and
that the commenter was mistaken. The commenter posted back with a
few different Pubmed abstracts that related to GBS suppression with
different applications of probiotics. I will post a link to this
whole discussion (I found it interesting). What I'm wondering is if
it is yet known scientifically whether or not probiotics will
actually prevent or suppress GBS colonization. The pregnant woman
with a science background did not seem to think that any of the
studies showed probiotics could be beneficial in this application.
Here is a link to the site where I read about all of this. I thank
anyone who can shed some light on this for me. I will suggest daily
probiotic use to all my pregnant clients if this is the case.

Henci Goer

I have not searched out any research on the effectiveness of
probiotics, but my understanding of probiotics is that they can
help maintain and restore the normal harmless and beneficial flora
and fauna that are indiscriminately killed off by antibiotics, not
that they have any antibacterial effect themselves. In women who
are given antibiotics, such as GBS + women, they are useful for
preventing problems such as thrush, a yeast infection that can, for
example, inflame nipples and the baby's mouth, wreaking havoc
with breastfeeding.

-- Henci

Archived User

Henci and others- Here are some abstracts from studies listed in
PubMed relating to probiotics and pathogens in the urogenital
tract. If anyone has the time to read through the study texts, I
would appreciate knowing your different interpretations of
them.

Neonatal group B streptococcal (GBS) infections are one of the
important health problems because of their high mortality and
morbidity rates in certain countries. There are some preventive
approaches, including perinatal antibiotic therapy against these
infections. Recently, vaccination with conjugated GBS
polysaccharides has also been practised. In this study, the in
vitro inhibitory effects of 51 lactobacilli (of them 50 were
purified from vaginal swabs, 1 from a commercial vaginal tablet) on
five GBS (4 clinical isolates and 1 standard strain) were
investigated by sandwich plate technique and deferred antagonism
well technique. Ten clinical isolates (20%) and the drug-purified
Lactobacilli expressed pronounced inhibitory effects on growth of
GBS. All of the inhibitory isolates and 10 randomly selected
non-inhibitory isolates were identified by API 50CHL kit
(BioMeriéx, France). Seven (70%) of the inhibitory clinical
isolates were Lactobacillus rhamnosus. The inhibitory isolates had
higher acid production than the non-inhibitory ones (p < 0.05),
and pH-adjustment destroyed their inhibitory effects entirely. If
these results could be applied in vivo, it could be postulated that
administration of certain lactobacilli as probiotics via an
appropriate regimen may be a safe, physiological and cheaper
alternative for prevention of neonatal GBS infections.

BACKGROUND: The relationship between lactobacilli and other
microbes and the association with vaginal pH in the female genital
tract were examined. The study also included evaluation of the
possibility of supplying probiotics to the genital tract by using
panty liners impregnated with the probiotic strain Lactobacillus
plantarum LB931. METHODS: This was a randomized,
placebo-controlled, double-blind, multicenter study involving 191
healthy fertile women. Specified microbes were counted and vaginal
pH was measured once a month for five consecutive months. RESULTS:
Major individual variations in the genital microflora composition
and the vaginal pH were found among the women. The number of
lactobacilli was significantly related to vaginal pH (p

Henci Goer

The abstracts for these studies sound intriguing. I have not
heard of any harm of probiotics (anyone who has, please chime in!),
so I don't see any reason not to try probiotics as a preventive
measure. The best that can happen is that they knock out GBS and a
woman who would have been positive for GBS tests negative. At
worst, they can help maintain/restore the
normal bacterial population if a woman has IV antibiotics
in labor for GBS colonization. It's a win both ways.

-- Henci

Archived User

I just got my GBS screen results back. It was negative this time.
With my first child, I was positive. I have been taking probiotics
in anticipation of taking oral antibiotics (having an HBAC), so
maybe the probiotics do help.

Henci Goer

Well, GBS comes and goes, so your experience doesn't constitute
evidence in the formal sense of the word. Still, the bottom line is
that so far as I know, probiotics don't hurt, and you may be
an example that they might help.

-- Henci

Archived User

is there any probiotic in particular that you would recommend
taking? my 3rd daughter died after 22 hours, having
contracted group B strep from me during labour and if probiotics
might help with the colonisation I would like to try them before
getting pregnant again.

Henci Goer

I am so sorry that this tragedy has touched your life. I cannot
make any specific recommendations, but I am sure that someone in
your community can help you choose a brand if you would like to try
them. Remember, though, that GBS is a silent infection that
comes and goes, so getting rid of it at some point before or during
pregnancy will not necessarily solve the problem. That is why
giving antibiotics during pregnancy is not protective, although it
would seem to be the logical solution. The organism lives in the
lower digestive tract and colonizes the lower vagina. Prevention
measures would therefore also include good bathroom hygiene: always
wipe from front to back, and (pardon my frankness) if a couple
engages in anal sex, do not enter the vagina once the penis has
been in the rectum.

-- Henci

Archived User

I'm freaking out! I'm so sorry to hear about your daughter :( my
condolensces! I am 39 weeks pregnant and am GBX positive. My
ob mentioned while she was doing an internal, that "she's stripping
the membranes" i had no idea what this meant, and did some research
this morning. IT seems that its recommended to not strip the
membranes in a woman who is gbs+. Were you put on antibiotics
during your labor with your 3rd daughter? I just read that
stripping the membranes, and doing internals may cause infection to
go into the womb......

Henci Goer

You may not hear a response from "Janey." Her post was written
in March 2009.

Please do not be anxious! If you have tested positive for Group
B strep, you should be receiving antibiotics in labor, a routine
precautionary practice that almost completely eliminates the chance
of your baby contracting an infection from exposure during labor.
That being said, while there is no official policy on labor
management, it makes good common sense not to increase the chance
of exposure by membrane stripping, breaking the bag of waters,
internal exams--especially after membranes have ruptured--or
internal monitoring of fetal heart rate or contractions. The
organism migrates from the anus and tends to live more toward the
vaginal outlet. All of these practices have the potential of moving
the bacteria up to the cervix, opening a pathway for it to enter
the uterus, or both, and none of them have been shown to offer
important benefits such as reducing cesarean rates or improving
newborn outcomes. I should add, too, that neither inducing labor
nor scheduling a c/sec are recommended for the treatment of women
who test positive for Group B strep. Finally, because antibiotics
kill off good bacteria as well as bad, you may wish to take
probiotics to replace them. This may avoid some of the problems
that can arise such as thrush, a yeast infection, that
can cause problems with breastfeeding: very sore nipples in
the mother, painful mouth in the baby.

~ Henci

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